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SP <br />ERTHOLOER.COPY <br />STATE _ P.O. BOX 807, SAN FRANCISCO,CA 94142-0807 <br />CORAPEN'SATION <br />INSURAN.`CE <br />U N D CERTIFICATE OF .WORKERS' COMPENSATIQN INSURANCE <br />ISSUE DATE: 04-01-2003 'GROUP: <br />POLICY NUMBER: 1296302-2003 <br />"' ` CERTIFICATE ID: 43 <br />CERTIFICAT€ EXPIRES: 04-01-2004 <br />04-Oi-2.003f04-O1-2004 <br />C f TY OF SANTA ANA SP Z <br />ATTN °ILIONA DE ROSA CONTRACT.SPECIALfST E ~~++ <br />20 CIVIC CENTER PLAZA M-43 ~ ~'y <br />SANTA ANA CA 92702' <br />This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved try .the <br />California Insurance CG17irrlissiOner to the e„~ploysr named. balaw far the aohCy pericd ind.catcd. <br />This policy is not subject to cancellation by -the .Fund except upon 30 days' advance written notice to the employer. <br />We will also give you 30 days' advance notice should this policy be cancelled prior to its normal expiration. <br />This certificate of insurance is .not an .insurance policy and does not amend, extend or alter the coverage afforded <br />by the policies,;<{fisted herein. Notwithstanding any requirement, 4erm, or condition of any 'contract :or other document <br />with respect,_tp which this°certificate of insurance may be issued or may.pertam,::'the .insurance:afforded" by the <br />policies described herein is subject to all the terms, exclusions and conditions of such policies. <br />AUTHORIZED REPRESENTATIVE PRESIDENT <br />EMPLOYER'S:,LIABILITY LIMIT INCLUDING DEFENSE COSTS: ..$1,000,000.00 PER OCCURRENCE. <br />ENDORSEMENT 1{3065 ENTITLED CERTIFICATE HOLDERS' NOTIGE'EFFECTIVE 04-01-2003 IS ATTACHED TO AND <br />FORMS A PART OF THIS POLICY.' <br /><. k ~~Uw:Ell, AS 70 FORI,: <br />,4 T <br />,. <<; City Attorney. <br />EMPLOYER <br />LEGAL NAME <br />SQUTHLAND :CAR COt1NTERS sourH~AN~ COMMUNICATIONS & DATA INC <br />1407 N_ BATA,V I A ST STE 107 <br />ORANGE CA 9286.7 <br />PRINTED: 03-17-2003 P0408 <br />~• ~ - -• ~ ~ <br />